TAP CHI Y DUgC HQC CAN THO - SO 11-12/2018
3. Hpi tim mach Viet Nam (2016), Bdo ddng: han 5000 ngu&i Viit Nam mdc binh tang huyit dp, H6i Nghi Tang huyit ap VietNam lan thii II nam 2016.
4. Nguyin Thi Que Huong (2014), A^gAjen ciru tinh hinh tdng huyit dp vd mgt sd yiu 16 lien quan cua ngu&i ddn tu 25 tuoi tr& len tgi xa Giai Xudn, huyen Phong Diin, thdnh phd Cdn Tha ndm 2014, Luan van tdt ngliiep Bac sT Y Hpc D\r Phdng, Tnrcmg Dai Hpc Y Dugc c k Tho.
5. Ngd Quang Kha (2015), Nghiin cuu tinh hinh tdng huyit dp & nhung ngu&i tir 40 tuoi tra lin tgi xd My Khdnh. huyin Phong Diin. thdnh phd Cdn Tha ndm 2015, LuSn van t6t nghiSp Bac sT Y Hpc Dif Phong, Trudng Dai Hpc Y Dugc Cdn Tha.
6. Pham Thj TSm, Le Minh Huu va NguySn Tan Dat (2014), "Nghien cim tinh hinh tang huyit ^p va th\Tc hi^n theo ddi va dieu trj d ngudi tu 25 tudi ttd len tai huyen ChSu Thanh, tinh Hau Giang", Tgp chi Yhgc thuc hdnh. So 944-2014, tt. 311-315.
7. NguySn Van Thinh (2012), Nghiin cihi tinh hinh tdng huyit dp vd kiin thiic. thue hanh phdng chdng biin chting tdng huyit dp & ngudi tir 40 tudi trd lin tgi huyin Vi Thuy, tinh Hgu Giang ndm 2012, Luan an chuyen khoa cap II, Trudng Dai hpc Y Dugc Can Tha 8. Nguyin Lan Viet (2011), Tdng huyit dp: Vdn di cdn dirge quan tdm han, BSnh ngirdi cao
tuoi - Siic khde ddi sdng.
9. WHO (2004), Mortality and burden of disease attributable to selected major risks, GLOBAL HEALTH RISKS.
10. WHO (2008), Global Health Observatory, Raised blood pressure.
11. World Healtii Organization WHO STEPS Instiument, The WHO STEPwise approach to chronic disease risk factor surveillance.
(Ngdy nhdn bdi: 15/11/2017 - Ngdy duyet ddng: 08/01/2018)
TUAN THU DIEU TRI 6 B E N H N H A N H O I C H I T N G VANH CAP TAI T H A N H PHO C A N T H O
Phgm Thdnh Sudf\ Nguyin Thdn^'\ Cao Thi Kim Hohn^, Trhn Thi Nggc Tu\ HdLiBaoNggc\
Nguyin Hmfng Thdo^, Phgm Thi T&m', Taxis Katjt^
1. Trucmg Dgi Hgc YDugc Cdn Tho 2. Dgi Hgc Groningen, Hd Lan 3. Dgi Hoc YDugc Thanh Phd Hd Chi Minh
* Email: [email protected] TOM TAT
Muc tiiu nghiin ciiu: Xdc djnh muc do tudn thit diiu tri eua binh nhdn hdi chimg vdnh cdp (HCVC) trong sdu thdng ddu sau xudt vi^n; vd xdc dinh ly do khong tudn thu diiu tri a then diim sou thdng sau xudt vien. Boi tugng vd Phirffng phdp nghiin ciiu: Thuc hiin nghien diu tien cuu, cdt ngang moid tgi hai binh vi^nd thdnh pho Can Tha tir thdng 01/2015 din 04/2016. Tudn thii diiu trj dugc ddnh gid bdng bg cdu hdi tiidn thii dieu ti-i Morisky (the Eight-item Morisky Medication Adherence Scale, MMAS-8) d cdc th&i diim: mgt thdng, ba thdng vd sdu thdng sau xudt viin. Benh nhdn dugc xem la tudn thit diiu tn khi tdi khdm dung theo hu&ng ddn eua bdc sT vd cd diim MMAS-8 > 5. Ly do Idtdng tudn thii dugc xdc dinh dua vdo ngi dung cdc cdu hdi trong MMAS-8. Kit qud: Cd 95 b?nh nhdn dugc chon vdo nghien ciru v&i tudi trung vi (khodng tu v/
358
TAP CHI Y Dl/QfC HQC CAN THO - SO 11-12/2018
phdn) 64 (58;^ 79) vd 56,8% nam. Tudn thu diiu tri a ede th&i diem mgt thdng, ba thdng vd sdu thdng scoi xudt viin ldn lugt la 83.2%; 80.0%;yd 76,8%. Tuy nhien, khdng cd su khdc bi4t ed y nghia vi miic do tudn thu dieu tri a ba th&i diim (Cochran's Q test, p = 0,354). O th&i diim sdu thdng sau xudt viin, cdc ly do khong tudn thii diiu tri thu&ng gap nhdt la: quen/khdng diing thudc, khdng tdi khdm theo hu&ng ddn ciia bdc sT, vd cdm thdy phien khi phdi tudn thu chi dg diiu tri.
Ket lugn: Tudn thu diiu tri & benh nhdn HCVC tgi thdnh pho Cdn Tha khd cao vd giii dn djnh trong sdu thdng ddu sau xudt vien. Tuy nhien, vdn eon mgt ty 1$ ddng ki (gdn 25%) benh nhdn kem tudn thu cdn dugc cdi thi^n.
Tk khod: tudn thu dieu tri, hdi chimg vdnh cdp. Can Tha A B S T R A C T
M E D I C A T I O N A D H E R E N C E IN P A T I E N T S W I T H A C U T E C O R O N A R Y S Y N D R O M E IN C A N T H O C I T Y Pham Thanh Suol'*, Nguyen Tkang''^, Cao Thi Kim Hoang', Tran Thi Ngoc Tu',
Ho Le Bao Ngoc', Nguyen Huong Thao\ Pham Thi Tam', Taxis Katjo?
1. Can Tho University of Medicine and Pharmacy, Vietnam 2. University of Groningen, The Netherlands 3. University of Medicine and Pharmacy at Ho Chi Minh City Objectives: to determine the level of patient adherence to treatment for acute coronary syndrome (ACS) in the first six months after hospital discharge and to identify reasons nonadherenee at six months. Materials and Methods: We conducted a prospective cross-sectional study on patients with ACS in two public hospitals in Can Tho city, Vietnam from January 2015 to April 2016. Adherence was measured using the Eight-item Morisky Medication Adherence Scale (MMAS-8) at one, three, and six months after discharge. We defined patient adherence to treatment as returning for their scheduled outpatient appointments and having an MMAS-8 score qf>5 at follow-ups. Reasons for nonadherenee were identified based on the content of the MMAS- 8 items. Results: Overall, 95 patients were included, median (interquartile range) age 64 (58; 79) years, and 56.8% males. Patient adherence at one, three, and six months after discharge was 83.2%, 80.0%, and 76.8%, respectively (Cochran's Q test p=0.354). At six months, missing/forgetting taking medicine, not complying with medical visits, and hassling to stick to treatment were the most frequently reported reasons for nonadherenee. Conclusions: Adherence to ti-eatment among patients with ACS in Can Tho city was relatively high and stable during six months after discharge, but there is still room for improvement
Rewards: medication adherence, acute coronary syndrome, Vietnam I. D A T V A N B E
Co khoang 54-86% benh nhan hOi chiing vanh cdp (HCVC) kSm tuan thu diSu tri [1]; ttong dd, a cac nude cd thu nhap thdp va trung binh, ty IS kSm t u ^ thu cd the cdn cao hon [2]. Tuan tiiu diSu tii giiip giam nguy co tu vong va cac ganh nang benh tat ciing nhu chi phi dieu tri cho benh nhan benh mach vanh va cac benh ly tim mach khac [3,4]. Tuy nhien, van cdn thieu cac nghiSn ciiu ve tuan thu diSu tri d benh nhSn HCVC tai Viet Nam, noi ma HCVC ciing la mdt ttong nhihig nguyen nhan tii vong cao nhat [5]. Vi v|iy, chiing tdi tiin hanh nghiSn ciiu ve "Tudn thu diiu trj de b^nh nhdn h^i chiing vanh c&p tgi thdnh pho Chn Thof" vdi muc tieu: (1) xac dinh miic do tuan thii diiu tri ciia benh nhan HCVC ttong sau thang dau sau xuat viSn va (2) xac dinh ly do khdng tuan thii diiu tii d thdi diim sau tiiang sau xudt vipn.
359
TAP CHI Y Dl/QC HQC CAN THO - SO 11-12/2018 II. D O I TU^ONG VA P I H T O N G P H A P N G H I E N ClTU
2.1. Doi t u ^ g nghiSn cmi
BSnh nhan sdng tai Cdn Tho va nhap vien tai benh vien Da Khoa Trung Uong Cdn Tho va bSnh vien Da Khoa Thanh Phd Cdn Tho cd mdt ttong cac chan doan khi xudt vien la (1) dau that nguc khdng dn dinh, (2) nhdi mau co tim (NMCT) cdp khdng ST chSnh len va (3) NMCT cdp cd ST chSnh len. Loai trii cac trudng hgp: (1) benh nhan khdng thi giao tiSp tiing Viet; (2) bSnh nhSn nhan thiic kem (dugc danh gia vdi diem sd bd cau hdi tam thdn tdi thiSu dudi 18/30); (3) benh nhan tii vong ttong vdng sau thang sau xudt vien.
2.2. Fhu-<mg phdp nghiSn cvu
Thiit ki nghien ciru: TiSn ciiu, cat ngang md ta cd phan ti'ch.
Cff mdu va thoi gian nghiin ciru: Chgn tdt ca cac benh nhan thoa tiSu chudn tir thang 01/2015 din thang 10/2015. Mdi benh nhan dugc theo doi ttong 6 thang sau xuSt vien. NghiSn ciiu kit thuc vao thang 04/2016.
Thu thdp so liiu: Gdm 3 buac: (1) Thu thgp sd lieu tir HSBA: Tudi, gidi, tien sii benh, yiu td nguy co, b?nh mdc kem, chdn dodn va don thudc khi xuat vien. (2) Phdng vdn true tiip benh nhdn khi ndm viin: Xin thdng tin lien l^c va y kiSn benh nhan va ngudi than ddng y tham gia nghiSn ciiu. (3) Phdng vdn true tiep benh nhdn sau xudt vien: G^p bpnh nhan tai benh vien hoac t^i nha bfnh nhan dS thu thap thdng tin ve tuan thu diSu trj d ba thdi diSm mpt, ba va sau thang sau xuat vien.
Ddnh gid tuSn thd diiu trf: Tuan thu diSu tti dugc danh gia bang b^ cau hdi tuan thii diSu tri Morisky (the Eight-item Morisky Medication Adherence Scale, MMAS-8) d ba thdi diem. BSnh nhan dugc xem la tuan thu diSu tri khi tai kham diing theo hudng dan cua bac sT va cd diSm MMAS-8 > 5. Bd cau hdi MMAS-8 da dugc dich va dieu chinh de su dung cho ngudi Viet [6].
Xac dinh ty li tudn thii diiu tri: Xac dinh ty le tuan thii dieu tri dua vao ty IS so benh nhan cd tuan thii ttSn tdng sd benh nhan dugc phdng van d m l i thdi diem.
Xdc dinh ly do khong tuan thu tgi thdi diem sdu thdng sau xuit viin: L^ do khdng tuan thii dugc xac dinh dua vao viec tai kham theo hudng dan va ndi dung cac cau hdi ttong bd cau hdi MMAS-8.
Xu ly sd li^u: Kit qua dugc trinh bay dudi dang: trung binh ± dd lech chuan (standard deviation, SD) hoac tnmg vi (khoang tii vi phan) (interquartile range, IQR) cho cac bien dinh lugng; ty IS % cho cac biin dinh tinh. So sanh ty le tuan thii diSu tri giiia ba thdi diSm dua vao Cochran's Q test. KSt qua cd y nghia thdng ke khi p < 0,05. Su dung SPSS 22.0.
2.3. D^o due trong nghiSn cuu
Nghien ciru dugc su ddng y ciia Trudng Dai hpc Y Dugc Cdn Tho, benh vien Da Khoa Trung Uong C§n Tho va bSnh vien Da Khoa Thanh Phd Cdn Tho. Cdc benh nh^n dugc giai thich ro rang ve muc dich nghiSn ciiu va ky phiSu ddng y tham gia nghiSn ciiu.
Nghien ciiu dam bdo tmh bao mat riSng tu cua cac ddi tugng tham gia nghlSn ciiu.
H I . K E T QUA N G H I E N ClTU
Cd 120 benh nhan dugc chpn vao nghiSn ciiu. Sau 6 tbang theo ddi, cd 95 dugc danh gia kit qua; 25 benh nhan khdng theo ddi dugc do: tir chdi tiiam gia (20) va tii vong (5).
3.1. Dac diem ban ddu cua b^nb nhSn nghiSn ciru
D|ic diem ban ddu ciia benh nhan nghiSn ciiu dugc trinh bay ttong Bang 1.
360
TAP CHl Y Dl/QC HOC CAN THO - SO 11-12/2018 Bang 1. Dac diem ban ddu ciia benh nhan nghien ciiu
Sac diem | Si b^nh nhan (N = 95) | Ty II (%) D^c diem chung
Tuoi, trung vi (IQR) Tuoi > 65 Nam giai CoBHYT
Trinh do hoc van > lop 6 Dang song vai vg/chong Phu thupc ve kinh te Phu thupc nguai cham soc thu6c
64 (58; 79) 44
54 82 36 63 50 15
46,3 56,8 86,3 37,9 66,3 52,6 15.8 Yen to nguy ca BMV va benh m^c kem
Tien sir gia dinh mac BMV Hut thuoc la
Tang huyet ap Dai thao duong Roi loan lipid mau Suy tim Suy than
Viem loet da day-ta trang Hen suyen/COPD So benh mac kem > 2
9 52 81 29 26 14 5 38 4 32
9,5 54,7 85,3 30,5 27,4 14,7 5,3 40,0 4,2 33,7 Chan doan khi xnat viSa
HCVC khong ST chenh len HCVC c6 ST ch«nh len
73 22
76,8 23,2 pel va thudc khi suat vi|n
PCI
Thuoc chong ket tap tieu cau Thuoc chen thy the beta giao cam Thuoc uc che men chuyen Statin
25 90 55 89 92
26,3 94,7 57,9 93,7 96,8
Chu thick: BHYT, bdo hiem y te; BMV, benh mgch vdnh; COPD, binh phdi tdc nghen mgn tinh; HCVC, hgi chiing vdnh cdp; NMCT, nhoi mdu ca tim; PCI, can thiip mgch vdnh qua da
3.2. Ty le tuan thu dieu tri or cac thai diem
Ty le tuan thii diSu tri d cac thdi diem dugc trinh bay d Bang 2.
Bang 2. Ty le tuan thii dieu tri d cac thdi diSm
Tnan thii*
Khdng tuan thii
Mot tbang sau suat vi|n (N=95), n (%)
79 16
(83.2) (16.8)
Ba thang sau suat vi^n (N-95),n(%)
76 20
(80.0) (20.0)
Sau thang sau xuat vi^n (N=95), n (%)
73 22
(76,8) (23,2)
TAP CHi Y Dt/pC HQC CAN THP - S6 11-12/2018 iT'^II^^BiSmkhong diing 1 7
huong dan
Difa MMAS-8 < 6 | 9 (7.4) (9.5)
8 12
(8.4) (12.6)
16 6
(16,8) (6,3) Chu thick: MMAS'8, bg cdu hdi tudn thu dieu tri Morisky; *Cochran's Q test cho thdy khde biit khdng ed y nghia vi tudn thti diiu ti-i giiia ba thai diim (p=0.354)
3.3. Ly do khdng tuSn thu dieu tri & thM diem s&u thang sau xuat viSn Ly do khdng tuan thii diiu tri d thdi diSm sau thang sau xuat vien d Bang 3.
Bang 3. Ly do khdng tuan thii diSu tri d thdi diem sau thang sau xuat vien Lydo
Tai kham khong dung voi huong dan ciia bac si Thinh thoang quen dung thuoc
Khong dung thuoc trong 2 tuan tro lai day T\r ngtmg diing thuoc khi cam thay sue khoe te ban Quen mang theo thuoc khi di du lich hoac di xa nha KhSng sir dung du thuoc ngay hom qua Ngimg diing thuoc khi benh duoc kiem soat Cam thay phien khi phai tu3n thii che do dieu tri G^p kho kh&n khi nha dimg tat ca cac loai thuoc
S6 bSnh nhSn
16 13 17 5 1 4 4 10 1
Ty le % (N-79)«
16,9"
16,5 21,5 6,3 1,3 5,1 5,1 12,7 1,3 Cha thich: *N=79, chi ed 79 b?nh nhdn dugc ddnh gid bg cdu hdi MMAS-8 vi 16 benh nhdn cdn lgi khong tdi khdm diing hudng ddn; **N=95, tdt cd benh nhdn diu duoc
IV. BAN L U ^
KSt qua nghiSn ciiu cua chung tdi cho thay cd ban 75% benh nhan HCVC tuan thu diSu tri ttong sau thang sau xudt vien. Ci thdi diSm sau thang sau xuat vien, cac l^ do khdng tuan thu dieu tri thudng gap nhdt dugc benh nhan bao cao la: quen/khdng diing thudc, khdng tai kham theo hudng dan cua bac sT, va cam thdy phiSn khi phai tuan thu che do dieu trj.
Cac nghiSn ciiu tnrdc day da cho thay nhieu benh nhan benh mach vanh kem tuan thii diSu tri sau khi xudt vien [1]. KSt qua cua nghiSn ciiu GRACE (the Global Registry of Acute Coronary Events) cho thay cd khoang 8-20% benh nhan ngung sir dung cac thuoc dugc chi dinh sau sau thang xudt vien [7]. Cac nghien ciiu khac ciing cho thdy ty IS tuong tu [8,9]. Bai tong quanhS thdng cuaNaderi va cgng su (2012) cung cho tiidy ty IS tudn thu dieu tri d benh nhan khd dn dinh ttong 6 thang ddu sau xudt viSn [10]. Cac ly do nhu quSn/khdng dimg thudc va cam thdy phiSn khi phai tuan thii chi do dieu trj cung dugc bdo cdo la cac ly do phd biSn nhdt ttong cac nghien ciiu d cac nude kMc [9,11].
DiSm manh ciia nghiSn ciiu nay la thiet ke tien ciiu, chung tdi theo doi tuan thu dieu tri ciia benh nhan ttong thdi gian dai tii khi xudt vien cho dSn tiidi diim sau tiiang sau xuat vien. Bd cau hdi MMAS-8 sir dung dl danh gia tiian thii diiu tri da dugc dich va diiu chinh dS sii dung phii hgp cho nhdm dan so nghien ciru la nguoi Viet [6]. Trudc dd cd rdt it nghiSn ctiu danh gia mtic dO tuan thii diiu tti ciia benh nhan HCVC d timg thdi diim cu thS sau xuat vien. Kit qua nghien ciiu cua chiing tdi cd thS giiip ngudi diSu tri chii y han den cac ly do khdng tuan tiiii diiu tri cua benh nhan d l cd chiSn luge can tbi^p phu hgp 362
TAP CHf Y DirgfC HQC CAN THQ - S6 11-12/2018
km can thiSt. NghiSn ciiu cung la budc co ban ban dau cho cac nghiSn ciiu tiSp theo vS tuan thu dieu tri (danh gia miic do tuan thu, cac yiu td du doan, 1^' do khdng tuan thii va cac bien phap can thiep) d benh nhan benh mach vanh cung nhu cac bSnh man ti'nh khac d Viet Nam.
Nghien ciiu cd mdt sd diSm ban chS. Thu nhdt, chiing tdi chua tinh cd mau cho nghien ciiu vi chua cd nghiSn cmi phu hgp trudc dd ttSn nhdm benh nhan nghiSn cihi tgi Viet Nam de udc tinh. Tha hai, nghiSn ciiu chi chgn hai benh vien Da Khoa Trung Uong can Tho va Da Khoa Thanh Phd Cdn Tho, vln cdn mat sd b?nh vien t ^ thanh phd Cdn Tho cd diiu tri cho benh nhan HCVC. Tuy nhiSn, day la hai b?nh vien cdng lon nhdt tgi Can Tho nen ty ie benh nhan HCVC tai Can Tho dugc diSu tri tai hai benh viSn nay cung cao. Thu ba, nghiSn ciiu sii dung bd cau hdi MMAS-8 d l danh gia tuan thu dieu tti ciia benh nhan. Day la mdt cdng cu do ludng mang tinh chu quan, benh nhan cd the vi muon lam hai Idng ngudi phdng van ma tta Idi sai vdi thuc te sir dung thudc. Tuy nhien, cdng cu do ludng nay da dugc danh gia dang tin cay va cung cho kSt qua chinh xac nhu nhiing cdng cu do ludng khach quan khac [12-14]. Hon niia, cac nghiSn ciiu vien danh gia kit qua da dugc tap huan trudc nhdm giup dam bao ket qua do ludng dugc chinh xac hon.
Danh gia tuan thu diSu tri bang bp cau hdi phdng van hoac b^ cau hdi tu tta Idi cung la bien phap phu hgp nhat vS mat kinh tS va tinh kha thi dS cd thS ap dyng rdng rai cho benh nhan d nude ta hiSn nay. Cudi cung, vln cd mgt ty IS dang ke benh nhan tir chdi tiep tuc tham gia nghien cim (17%), diSu nay cd the anh hudng dSn kSt qua nghiSn ciiu.
V. K E T L U ^ N
Ty le tuan thu dieu tri d benh nhan hdi chiing vanh cap tai thanh phd Can Tho tirang ddi cao va dn dinh ttong vdng sau thang dau sau xuat vien. Tuy nhiSn, van cdn nhilu kha nang d l nang cao ty le tuan thii nay. NghiSn ciiu tiSp theo can tim hiSu cac yeu td hSn quan dSn viec kem tuan thu ciing nhu xay dung dugc cac bien phap can thiep giiip nang cao tuan thii diiu tri ciia benh nhSn. Can thiep bdng each tu vdn sir dung thudc bdi dugc Sl ciing la mdt phuong phap dugc nhiSu nghiSn cim d cac nude khac chimg minh hieu qua tich cue [15].
TAI L I E U T H A M K H A O
1. Chen HY, Saczynski JS, Lapane KL, Kiefe CI, Goldberg RJ. Adherence to evidence-based secondary prevention pharmacotherapy m patients after an acute coronary syndrome: A systematicreview. Heart Lung. 2015;44: 299-308.
2. Akeroyd JM, Chan WJ, Kamal AK, Paianiappan L, Virani SS. Adherence to cardiovascular medications in the South Asian population: A systematic review of current evidence and future directions. World J Cardiol. 2015;7: 938-947.
3. Bitton A, Choudhry NK, Matlin OS, Swanton K, Shrank WH. The impact of medication adherence on coronary artery disease costs and outcomes: a systematic review. Am J Med.
2013;126: 357.e7-357.e27.
4. Chowdhury R, Khan H, Heydon E, Shroufi A, Fahimi S, Moore C, et al. Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. Eur Heart J. 2013;34:2940-2948.
5. Viemam Ministry of Health. Vietnam healtii statistical profile 2009-2013. Viemam Ministry of Health. 2013.
6. Nguyen T, Nguyen TH, Pham ST, Cao HT, Le KK, Pham HT, et al. Translation and cross- cultural adaptation of the brief illness perception questionnaire, the beliefs about
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TAP CHI Y DiXOC Hpc CXN THO - S6 11-12/2018
medicines questionnaire and the Morisky Medication Adherence Scale into Vietnamese.
Pharmacoepidemiol Drug Saf. 20!5;24: 159-160.
7. Eagle KA, Kline-Rogers E, Goodman SG, Gurfinkel EP, Avezum A, Flather MD, et al.
Adherence to evidence-based therapies after discharge for acute coronary syndromes: an ongoing prospective, observational study. Am J Med. 2004; 117:
73-81.
8. Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avom J. Long-term persistence in use of statin therapy in elderly patients. JAMA. 2002;288:455-461.
9. Kassab Y, Hassan Y, Abd Aziz N, Ismail O, AbdulRazzaq H. Patients' adherence to secondary prevention pharmasotherapy after acute coronary syndromes. Int J Clin Phami.
2013;35:275-280.
10. Naderi SH, Bestwick JP, Wald DS. Adherence to dmgs that prevent cardiovascular disease: meta-analysis on 376,162 patients. Am J Med. 2012;125: 882-7.el.
11. Khanderia U, Townsend KA, Erickson SR, Vlasnik J, Prager RL, Eagle KA. Medication adherence following coronary artery bypass graft surgery: assessment of beliefs and attitudes. Ann Phamiacother. 2008;42: 192-199.
12. MorislQ' DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008;10; 348-354.
13. Morisky DE, DiMatteo MR. Improving the measurement of self-reported medication nonadherenee: response to authors. J Clin Epidemiol. 2011 ;64: 255-7; discussion 258-63.
14. Krousel-Wood M, Islam T, Webber LS, Re RN, Morisky DE, Muntner P. New medication adherence scale versus pharmacy fill rates in seniors with hypertension. Am J Manag Care. 2009;15:59-66.
15. Santo K, Kirkendall S, Laba TL, Thakkar J, Webster R, Chalmers J, et al. bterventions to improve medication adherence in coronary disease patients: A systematic review and meta-analysis of randomised controlled trials. Eur J Prev Cardiol. 20I6;23; 1065-1076.
(Ngdy nhgn bdi: 13/11/2017 - Ngdy duyit ddng: 05/01/2018)
CAC YEU TO TIEN LUOfNG NGUY CO TU^ VONG VA TAI mU^ VIEN TRONG M O T THANG SAU XUAT VIEN
6 BENH NHAN HQI CHlTNG VANH CAP
Li Kim Khdnh'*, Nguyin Th&n^, Thdi Nggc Diim Tran^, Nguyin Hmmg Thao\ Phgm Thi Tam', GS.TS. Taxis Katja^
1. Tru&ng Dgi Hgc YDuac Can Tho 2. Dgi Hgc Groningen, Hd Lan 3. Dgi Hoc YDugc Thdnh Phd Hd Chi Minh
*Email: [email protected] TOM TAT
Mgc tiiu nghien cuu: Xdc djnh ty 1$ tir vong vd tdi nhgp viin vd cdc yiu td tiin lugng nguy ea tir vong vd tdi nhgp viin trong mdt thdng sau xudt vi^n & binh nhdn hdi chung vdnh cdp.
Boi tuang vd Phuang phdp nghiin ciiu: Thuc hien nghiin euu tiin eiiu, cdt ngang md td tgi hai benh vien a thdnh phd Can Tha. Tated cdc b$nh nhdn nhdp viin tt-ong^ khodng th&i gian tir thdng 01/2015 den 10/2015 thoa tieu chudn dugc ehon vdo nghiin cuu. Mdi binh nhdn dugc theo ddi 364
